A case of calcinosis circumscripta.

Calcinosis, or chalk gout as it is commonly named owing to the tophus-like swellings it presents, is a slowly progressing condition of unknown aetiology and pathogenesis. Two types are described, circumscripta and universalis. The female sex is the more commonly affected. The circumscripta variety usually occurs in those in middle or late life. Discussion Atkinson and Parkes Weber (1938) from whose paper most of the references given below are quoted, state, in a complete survey of the condition, that the first case of calcinosis was described in 1878 by H. Weber, and that Leissier in 1877 recorded the case of a woman aged 21 years who had 'had since childhood hard nodules in the skin and subcutaneous tissues: there was a discharge of chalky particles, and he believed his case to be one of gout associated with scleroderma. In 1844 Virchow described metastatic calcification in nephritis. In 1899 Derville published a case, and in the same year Durett suggested a familial incidence, but this was not proved. In 1900 Profichet wrote a thesis on calcinosis, with a resume of all cases published up to date. It was afterwards called by foreign writers the syndrome of Profichet. Riche reported a sulphuric-acid worker who formed nodules of calcium carbonate and phosphate. In 1902 Hutchinson reported a case of a woman aged 58 years who probably suffered from scleroderma; the fingers felt wooden, and calcareous plaques were found in the deep layers of the skin of the forearms. This seemed to be a case of scleroderma with calcinosis, and was the first published in England. Lehrenbecker in 1927 described a patient who had formerly undergone bilateral sympathectomy for Raynaud's disease and in whom calcification later supervened. The author wondered whether the operation had been the exciting cause of the calcinosis. Steinitz (1930) reported a case in a woman aged 82, the oldest patient on record. Brauer believed ovarian function was diminished and that this fact had something to do with calcinosis. He also believed that circulatory disturbances might have favoured a chalky deposition. Wilson (1935) thought the deposits of calcium phosphate found in the fingers of one of his cases might have been due to an endogenous hypervitaminosis D connected with an unusually high blood cholesterol, superimposed on old Raynaud's disease which had remitted. The same authors state that sclerodactylia and scleroderma are frequently associated, the joints remaining free. They state that calcinosis …